A week later than intended the Department of Health [DH] has published the calorie reduction pledges that it has secured from the food industry as part of its Responsibility Deal plan. The announcement was to have been made on March 14th to celebrate the 1st Anniversary of the idea of pledges being agreed and the script for the day called for a fanfare tp herald a number of " momentum building " exemplars to showcase the commitment of industry to health. Unfortunately, key industry players such as McDonalds, KFC and Burger King didn't read the script and the announcement has had to be made without them pledging anything. The fact that the DH Press Release publicising the pledges was embargoed to midnight last night also gives the impression that someone thought that a Saturday would be a better day to bury " not such good news ".

The Deal is, however, a beginning with a lot more work to be done - and DH has admitted as much. In the end, the National Obesity Forum believes that regulation/legislation will be required to bring everybody into line: the majority of the 75% of brands who signed the pledge have only " promised " to do things: they have not specified how many calories they will take out and by when. Coca Cola - acknowledged by NOF for its commitment to swap sugar for sweeteners in many of its soft drinks brands - is an exception. It will take 30% of calories out by 2014 by its use of stevia. Tesco should be also be complimented on its decision to make shopping for low-calorie products easier by adding a " Green Ping " label to the packaging - a " traffic lights " system if there ever was one! One day the UK will see the end to the impossibly complicated GDA food labelling system.

Major High St food outlets such as Costa Coffee, Pizza Express and Garfunkels have shunned the government initiative to reduce obesity by not displaying calorie counts with their products. The watchdog Which? has marked the 1st Anniversary of the launch of the Department of Health's [DH] " Responsibility Deal " with the food and drink industry by naming and shaming the companies that have declined to play ball. " If food companies don't agree to help people eat more healthily, " Which? insists, " then we must see legislation to force them to do so ". In reply, the DH has challenged the Which? list by stating that it had secured pledges that more than 70% of fast food and takeaway meals had calorie values attached - thanks to McDonalds, Pret a Manger, Yo! Sushi and Subway.

The Forum, listed by the GUARDIAN as a group which believes that legislation or regulation is long overdue, is particularly dismayed that the 1st Anniversary has not witnessed the DH naming the food giants who it lobbied to sign a calorie reduction pledge. Momentum-building exemplars were " promised " - but not delivered. If the DH wants to see 5bn calories less eaten daily across the nation, this will not be achieved by bits of calorie information here and there - but it might be with serious calorie reduction of food stuffed with high levels of fat, salt and sugar.

The Healthy Survey for England figures for 2010/11 show a 30-fold increase in 2010's bariatric surgery when compared to 2000. The 2000's 8,087 operations, even though they include 1,444 for band adjustments, dwarfs the 261 that were "headline news " 12 years ago. There was also a significant regional variation in the number of operations carried out and hospital admissions were also increasing - and increasingly varied across the country - and three times more women than men were being given a primary diagnosis of obesity. Tim Straughan,CEO of the NHS Information Centre which publishes the Survey, confirmed the growing impact of obesity on both people's health and NHS resources and suggested that health professionals working in the field might want to examine the regional discrepanicies.

Regional variations are very concerning to the National Obesity Forum [NOF] and, having examined them, it believes that they illustrate a postcode lottery which still exists in England. It is deplorable. Some Primary Care Trusts [PCTs] abide by the NICE [National Institute for Health and Clinical Excellence] in offering bariatric operations to obese patients but others flout it by making it virtually impossible even for the morbidly obese to qualify for the surgery. Hospital admissions vary similarly from region to region due to the disinclination of a significant number of surgeries referring needy patients. The premise is that obesity is the patients' own fault and that the NHS shouldn't be expected to pay for treatment.

Now here's a fast-food meal that will make YOU a whopper, runs the Daily Mail's headline. The paper states that Burger King's latest - a 966 calorie Smoked Bacon and Cheddar double Angus burger - has been blasted by health critics. Too right it has.

At a stroke, as they say in Westminster, the high street chain has run a coach and horses through the government's promise, made 24 hrs earlier, that people on the high street can be reassured that its Responsibility Deal with the food industry is working. Further proof that responsibility appears not to be in the forefront of the food industry's mind is Tesco's decision to sell £1 bars of Kitkat for 20p in order to lure customers back into their stores after Christmas! The chain also decided to put Easter Eggs on its shelves on Boxing Day [although it upset one customer who criticised her store for forgetting that chocolates for Valentine's Day should have been its priority!]. Finally, another Responsibility Deal backer, McDonalds has proudly added to the calorie count by declaring that 100 million additional customer visits darkened its doors in 2011. Big Macs are now available in 384 round-the-clock franchises that operate seven days a week. Enjoy.

But take heart if you are reading this in the UK. USA media are amazed that the National Obesity Forum is carping at a 966 calorie item. They suggest that we might be quite lost for words when presented with the 1,000+ calorie burgers that ring the tills across the Atlantic. How long will it be, one wonders, before these gut-busting meals pop up here because our government has lost any stomach to take on Big Food?

Although they have been available for some time as treatments for diabetes, drug Byetta and Victoza - drugs that mimic a gut hormone suppressing appetite - looks as if they might be a simple once-a-day injection that takes care of obesity, too. National Obesity Forum chairman, Professor David Haslam, says tha they really have the potential for revolutionising treatment. " Safety wise they are pretty good. I am using them on my patients and have had a lot of success. For some they have helped lose four stone and have brought blood sugar under control for the first time ". The have also helped patients blood pressure and reduced cholesterol and enzyme levels.

It is not all good news of course. Common side effects include nausea, vomiting and diarrhoea but trails reported in the BMJ [Jan 14th] suggest that overall patient satisfaction with the treatment is relatively high. Thankfully a drug for obesity may be no longer limited to Alli or the XLS Fat Binder pills available over-the-counter at pharmacies.

If you want to know what your girlfriend's going to look like in middle age, look at her mother. Researchers at the Glasgow University confirm that bigger families are having bigger children and that daughters seem to inherit more from their mother. The Glasgow study found that, of its female cohort, 17% were obese mothers but 20% of daughters were obese, a far higher proportion than among fathers and sons or mothers and sons.

The Scotsman's Sunday edition headlined its coverage " Children who shall inherit the girth " - a laudable title for a newspaper produced on the sabbath. Its take home message is, again, commendable. The message? All children with overweight/obese parents and at risk of becoming so themselves, should be monitored for unhealthy weight gain from birth.

If you follow French diet guru Pierre Dukan you just might support his call to award better marks to " baccalaureat " students " if they stay slim. However, if you don't, you would be correct in thinking that his educational advice is as flawed as his fad Dukan Diet. The Western Mail reports that the controversial exams suggestion should be avoided in Wales - and states that France's obesity umbrella gropup, CBNO, is none too enamoured of it either. The Daily Telegraph, which also covers the story, quotes the groups's president, Anne-Sophiel Joly, as anticipating playground taunts such as " Fatso!, you'll never get your bac! ".

The House of Commons' cross-party Health Select Committee considers that the government's Responsibility Deal with food and drink firms to improve public health will not solve the huge problems of obesity and chronic drinking. The Committee's report, examining Government reforms proposed for Public Health, echoes concerns expressed by the British Medical Association, campaigneers and celebrity chef, Jamie Oliver. The government must be ready to use legislation if industry fails voluntarily to reformulate its unhealthier products and " nudging " the population into heahier lifestyles also fails. For it's part, the Department of Health refutes this approach and is adament that working with industry will provide the solution. It insists that it is the Department and not industry that is setting the health agenda.

The National Obesity Forum [NOF] simply repeats it condemnation of the Department's strategy to tackle obesity and has broadened its demand for a comprehensive Inquiry into the epidemic [see below]. NOF understands that the National Audit Offioce and Commons' Public Affairs Committee's have also identified obesity for further reports: it is NOF's opinion that a joint Inquiry by all three bodies should be timetabled for early 2012.

This demand takes into consideration that the House of Lords Science and Technology Committee has already inquired into " nudging " and was told by a senior Conservative that it was " an open question whether nugging will have any effect on behaviour change whatsoever ".

The National Obesity Forum, together with the Child Growth Foundation - the UK charity focussed on the prevention of chidhood obesity - has called for a second House of Commons Inquiry into Obesity following the publication of " Call to Action ", the Department of Health's strategy to accomplish a downward trend in obesity by 2020. It is seven years since the Select Committee published its seminal report on obesity - and comparatively little has been achieved to stem the epidemic since.

The NOF calls the government's strategy " hopeless ". Chairman Professor David Haslam told GP, the general practice weekly, that " Call to Action wouldn't make a single person thinner. It is meaningless to primary care and I almost completely object to it ". He also had some choice words for the " Dietary Recommendations for Energy " document released simultaneously with " Call to Action ". Commenting on the new recommendations - which increased the calorie count -he castigated the increase for being " really unhelpful ". " It gives out entirely the wrong message." he said. " People are going to think that they can eat that little bit more. If anything, that will add to the obesity problem!"

" Call to Action " whose chief message is that the UK should strive for a collective daily reduction of 5 billion calories as a " new national ambition ", has received flak from all quarters except, of course, the food and drink industry. Jamie Oliver's view that the document was " worthless, regurgitated, patronsing rubbish " was the opinion most quoted.

An Australian consumer group has launched the " Shame the Claim " campaign to encourage people to reveal those food products that present healthy claims but are far from good for you. The group states that parents in particular have signed up having had enough of the persistently deceptive marketing of unhealthy foods to children from food companies that should know better given the global rise in childhood obesity.

Analysis of statistics comparing the most recent government adult obesity estimates and the 2008/9 National Child Measurement Programme figures has found that 20 of the 22 areas that children were fatter than adults are in London. The DAILY MAIL, medicine which carried out the analysis, viagra buy maps out the other English hotspots.

The figures belie Department of Health assurances that the obesity epidemic is levelling off ". It may well be in affluent area - such as towns in the countryside and afluent areas surrounding big cities - but in inner cities the picture is not the same. For example, in Westminster, the " seat " of government, childhood obesity is 28.6%, 10% above the national English average.

The Glasgow Herald is reporting research* showing that obese Scots spend an average of 26 days in hospital compared to 17 for someone within the healthy weight range. The researchers from Edinburgh University trawled through medical records of some 16,000 men and women to examine the link between BMI and hospital stays. In response to the finding, a Scottish Assembly spokeswoman stated that " the environment we live in means that weight gain becomes almost inevitable " [* Scottish Medical Journal 28th August].

What an admission! Perhaps this statement will stop governments blaming obesity on the failure of individuals to make healthy lifestyle choices and start to ensure that their politicians focus on strategies to change the obesogenic environment in which their populations live. This week's THE LANCET spells out the measures that only governments can take.

The obesity crisis is being driven by a food industry bent on maximiising profits - but governments are failing to intervene to protect the health of their populations, leading scientists state. In the UK, the fattest nation in Europe, the number of obese adults is now forecast to rise by 78% over the next two decades resulting in more than a million extra cases of diabetes, heart disease and cancer. A series of research papers published in The Lancet* ahead of the United Nations/World Health Organisation [UN/WHO] High-Level Meeting on non-communicable diseases [New York Sept 19th/20th], lists 20 proven interventions for curbing obesity which show that eight would save costs as well as improving health. The researchers state that no country in the world is successfully tackling the threat as leaders fear the wrath of electors if they slap extra taxes on healthy foods. [* www.thelancet.com/series/obesity]

The INDEPENDENT is unique in both its coverage of The Lancet series but also for a Leader stating the case for a " fat tax ". This was echoed in interviews with Forum spokespeople by the BBC's News Channel, Radio 5 Live and 20 of the BBC's local radio stations that highlighted some of the 20 measures that The Lancet believes the UN/WHO should implement as soon as possible. The series of the Lancet papers should be required reading for anyone interested in tackling to-day's pandemic and preventing it taking further hold in the future.

THE LANCET is not alone in looking forward to the UN/WHO meeting. The BMJ chooses to ask whether or not vested interest will bring the meeting to its knees. In a paper " Will industry unfluence derail UN summit? ", it raises serious concerns about the " powerful sway " of tobacco, alcohol, food and drug industries. This concern is then supported by a Commentary declaring that the meeting will be a " battleground, pitting public interests against powerful private ones ". The two days may witness the emergence of a global social movement for change shaping the future of our health for years to come - or see it scuppered. [BMJ August 24th 2011]

French clinicians, check aiming to describe the association between BMI [Body Mass Index] and depression in teenage children, ailment report that overweight adolescent girls are more likely to be depressed than obese adolescent girls, giving support forthe " fat and jolly " hypothesis not only among older women but also among adolescent girls [source: BMC Public Health]

A team of researchers from Australia, diagnosis Denmark and Indonesia have come up with the suggestion that obesity should be measured in "obese years" or "BMI years", here analogous to the " pack years " concept used for smoking. Up to now obesity has been measured internationally only by the severity of the problem and not its duration. To do the latter would be much more meaningful because examining the association between obesity and the risk of mortality, nurse by considering only its severity and ignoring its duration, may have underestimated the adverse effects of the current epidemic [source: International Journal of Epidemiology]

The use of weight-loss drugs has risen by 65% and sales of other slimming products by 20% in this last year according to a survey by the The Co-operative Pharmacy. Chemists record that they have concerns that the rise could be the result of discrimination. 20% of people surveyed stated they had been victimised over their weight with women most likely to to say that they had been ridiculed about their bodies. Depression and stress were also cited as the greatest influence on weight gain. The survey urged people to consult their GP or pharmacist about ways of shedding weight.

Discriminating against the obese is deplorable with the psychological aspects of obesity often overlooked. Unfortunately GPs can still be very hesitant in talking about weight issues and be dismissive. They will be prescribing lifestyle advice before prescribing drugs - but increasingly it appears that their patients demand the latter or even bypass their GP to buy their pills over the counter.

To-day’s publication of the journal of the American Medical Association states that putting children temporarily in foster care is in some cases more ethical than obesity surgery. Dr David Ludwig, a US top obesity expert, states that the point is not to blame the parents but rather to act in the children’s best interests and get them help that for whatever reason their parents can’t provide [JAMA July 13th 2011]

Dr Matt Capehorn, NOF Clinical Director, asked a BMA conference in 2007 to agree that, in a worst case scenario, social services should be called in if a child’s health was at risk from its weight. The BMA declined but over the years, after a number of UK children have been so referred, many doctors have shifted their opinion. In its August 21st edition last year the BMJ [British Medical Journal] outlined when childhood obesity should become a child protection issue. It proposed a framework for practice.

The National Obesity Forum is recommending new standards for the management of obese people seeking to lose weight using Very Low Energy Diets (also referred to as Very Low Calorie Diets). Download the position statement here. [Adobe Acrobat PDF - 209.95 KB]

Men’s health under threat as vital warning signs are ignored. Have you ever been accused of having ‘Man-Flu’? New research reveals that the term, ‘Man-Flu’ adopted by many to ridicule men when they are sick, could be having a negative impact. In some cases, men feel that the term, ‘man-flu’ is denying them the right to be ill (43%) and preventing them from seeking advice for a legitimate illness (52%).

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